Prognostic significance of diastolic wall strain as a predictor of remodeling and poor outcomes in heart failure and pulmonary embolism: A systematic review

Background

Diastolic wall strain (DWS), also referred to as right ventricular (RV) dysfunction, is a significant predictor of pulmonary embolism (PE) and heart failure (HF). Rooted in linear elastic theory, DWS reflects decreased wall thinning during diastole, indicating reduced left ventricular (LV) compliance and increased diastolic stiffness. Elevated diastolic stiffness is associated with worse outcomes, particularly in PE and HF with preserved ejection fraction (HFpEF). This study systematically reviews the prognostic significance of DWS and its impact on PE and HF.

Methods

A systematic search of scientific literature published between 2014 and 2024 was conducted using PubMed and Cochrane Reviews. Keywords such as “diastolic wall strain,” “right ventricular dysfunction,” and “pulmonary embolism” were employed to identify relevant studies. Seven articles meeting the inclusion criteria were selected and analyzed to synthesize insights into DWS and its role in risk stratification and prognosis for PE and HF patients.

Results

The findings suggest that elevated DWS values are correlated with increased short- and long-term mortality in PE patients and a higher likelihood of early complications in both PE and HF. In cases where HF is present alongside elevated DWS, the risk of significant bleeding is heightened. DWS emerged as a reliable tool for PE risk stratification and predicting adverse outcomes in HF patients.

Conclusion

DWS is an essential prognostic marker for PE and HF, independently predicting major adverse cardiac events (MACE). Its straightforward assessment can improve risk stratification and guide clinical management in individuals at risk for cardiac failure.